Oculus Sinister Research Articles

Alterations of choroidal circulation and vascular morphology in a patient with chronic myeloid leukemia before and after chemotherapy

BackgroundChronic myeloid leukemia (CML) is known to cause leukemic retinopathy due to leukemia cell invasion into the choroid; however, details of the circulatory dynamics and morphological changes in the choroid are unknown. The aim of this study was to present a case of leukemic retinopathy and examine choroidal circulatory and structural analyses using laser speckle flowgraphy (LSFG) and optical coherence tomography with a binarization method, respectively.Case presentationA 15-year-old male diagnosed with CML complained of blurred vision in his right eye. He was ophthalmologically diagnosed with leukemic retinopathy due to retinal hemorrhage in both eyes. Tyrosine kinase inhibitors achieved complete cytogenetic remission and resolution of retinal hemorrhages at 6 months after treatment. After the treatment, the best-corrected visual acuity had recovered from 0.1 to 1.2 oculus dexter (OD) and remained at 1.5 oculus sinister (OS). The rate of change in macular blood flow assessed by the mean blur rate on LSFG was 18.3% increase OD and 25.2% decrease OS 19 months after treatment. The central choroidal thickness showed 0.4 and 3.1% reductions OD and OS, respectively. The binarization technique demonstrated that the rate of luminal areas in choroidal areas exhibited 3.2% increase OD but 4.8% decrease OS.ConclusionChoroidal blood flow improved OD after treatment for CML, while it deteriorated OS, together with choroidal thinning due to reduction of luminal areas. The degrees of leukemia cell invasion into the choroidal tissue and tissue destruction might be different between the eyes in this case.

Evaluation of lipid layer tear film changes after femtosecond small incision lenticule extraction.

Background:Dry eye disease is common after refractive procedures due to tear film instability. There are several causative factors for tear film instability, but the state of individual components of the tear film is not assessed much in published literature. This article quantifies the lipid layer thickness (LLT) of the tear film using surface interferometry before and after the small incision lenticule extraction (SMILE) refractive procedure.Objectives:This study aimed to evaluate the effects of femtosecond SMILE on the postoperative stability of the LLT of the tear film.Design:This was a prospective, interventional, non-case–control study.Methods:A total of 160 eyes of 80 patients were enrolled in the study. The follow-up period was 6 months after surgery. A noninvasive surface interferometer was used to measure the thickness of the lipid layer before surgery and was repeated at 3 and 6 months after surgery. The main outcome measure was the change in average LLT at 3 and 6 months after SMILE and its statistical significance.Results:There were 48 women and 32 men. Age ranged from 21 to 42 years (mean = 27 ± 6.4). Mean LLT at baseline was [oculus dextrus (OD) = 53.38 (±7.24) nm; oculus sinister (OS) = 52.21 (±6.95) nm], at 3 months [OD = 54.38 (±5.75) nm; OS = 53.26 (±5.70)], and at 6 months [OD = 53.31 (±5.66) nm; OS = 52.39 (±5.94)]. Mean LLT showed mild improvement at 3 months after surgery (OD = 53.38–54.38 mm, p = 0.0417; OS = 52.21–53.26 mm, p = 0.0398). There was no significant change in LLT from the baseline before surgery to levels 6 months after surgery (p = 0.8914 OD; p = 0.7368 OS).Conclusion:The SMILE refractive procedure did not alter the LLT that remained stable and adequate at 6 months postoperative follow-up.

Hyperopic shift after refractive lens surgery in a patient with prior history of radial keratotomy

Radial keratotomy (RK) was a popular refractive procedure in the 90s. However, more reproducible laser-assisted surgeries are currently preferred. Furthermore, RK patients who undergo cataract surgery experience variable refractive and keratometric changes during the early postoperatory period. Unfortunately, those post-RK patients currently require cataract surgery. A 58-year-old male with a history of RK in both eyes (OU) presented with a 2-year history of night glare and progressive vision loss due to a subcapsular cataract in OU. Using the double-K Holladay formula, bilateral phacoemulsification was performed. At 1 week, refraction was + 2.25/-1.00/27° (power [Pwr]: 39.25D) in oculus dextrus (OD) and + 3.00/−0.75/171° in oculus sinister (OS) (Pwr: 37.41D), achieving a best-corrected visual acuity (BCVA) of 20/30 OU. At 6 weeks, refraction was + 0.75/−0.75/18° (Pwr: 39.71D) in OD and + 1.00/−0.25/180° (Pwr: 38.33) in OS. BCVA remained 20/30 OU. The resulting transitory hyperopic shift after surgery demands a careful and comprehensive intraocular lens calculation preferably aiming toward myopic overcorrection.

Neovascularisation of the lens capsule: a unique finding

A 62 year-old man consulted for progressive loss of vision in both eye. His past ophthalmological history was unremarkable and he denied any known systemic condition. On examination, his best corrected visual acuity was light perception oulus uterque (OU). Papillary reaction to light was sluggish oculus sinister (OS) and normal OU. Ocular motility was full OU with normal intra-ocular pressure. Slit-lamp examination showed bilateral white mature cataract with low pharmacological dilation. High magnification under dilation revealed a vascular network composed of fine vessels located nasally adjacent to the papillary border on the anterior capsule of the lens associated with pigment deposits and loss of the papillary frill (A). There was no evidence of neovascularisation of the iris (NVI) or the angle neurovascular assessment (NVA). Ocular ultrasound was negative for vitreous hemorrhage or retinal detachment. Ancilliary testing for diagnosis of common aetiologies of anterior segment neovascularisation was carried out and revealed type 2 diabetes. The patient was referred for evaluation and control of his newly diagnosed diabetes. After six months, we performed an uneventful cataract surgery by phacoemulsification. Fundus fluorescein angiography (FFA) showed posterior segment ischemia with neovascularisation elsewere (B). Neovascularisation spared the iris and the angle. Thus, nerve conduction velocity (NVC) was the solely sign of anterior segment neovascularisation.

Retina mirrors brain pathology and response to GA immunotherapy in advanced stage AD-model mice.

Characteristic signs of Alzheimer's disease (AD) are increasingly reported in the neurosensory retina of human patients and animal models, however examination of the retino-cerebral relationship, especially at late disease stages and in response to therapy, is scarce. Transgenic models of AD (APPSWE /PS1∆E9 ; ADtg mice) treated with glatiramer acetate (GA) immunomodulation showed disease alleviation in pre- and early-symptomatic disease stages. Here, we explored the link between retinal and cerebral AD-related biomarkers, including response to GA immunization, in cohorts of old, advanced-stage ADtg mice. These mice were aged to become more clinically relevant to AD. To determine the extent of amyloid β-protein (Aβ) burden in retinal and brain tissues from treated and untreated ADtg mice, we developed a new protocol for extracting, unfolding and quantifying Aβ levels utilizing a Meso Scale Discovery biochemical assay, which recognizes human and mouse Aβ1-42 , Aβ1-40 , and Aβ1-38 proteins. Homogenates from these tissues were additionally analyzed by mass spectrometry for detailed global protein levels. Immunohistochemical staining for Aβ plaques, inflammation, infiltrating myeloid cells, and synapses were conducted on brain sections to reveal cerebral effects of GA immunotherapy. Levels of synaptotoxic Aβ1-42 , angiopathic Aβ1-40 , non-amyloidogenic Aβ1-38 , and Aβ42 /Aβ40 ratios tightly correlated between paired retinas derived from oculus sinister (OS) and oculus dexter (OD) eyes, and between left and right brain hemispheres. Brains and retinas displayed significant, one-side dominant lateralization of Aβ burden. Importantly, OS and OD retinal Aβ levels correlated with their cerebral counterparts, in advanced disease stage and following GA immunotherapy, with stronger contralateral correlations. Moreover, immunomodulation in old ADtg mice provoked reductions in vascular and parenchymal Aβ deposits in the brain, especially of large, dense-core plaque subtypes, and alleviation of microgliosis and astrocytosis. Immunization further enhanced cerebral recruitment of peripheral myeloid cells and synaptic preservation. Global proteome profiling by mass spectrometry revealed novel molecular parallels in retino-cerebral AD-related pathology and response to GA immunization, including restoration of homeostatic astrocytic glutamine synthetase expression. Overall, our results support the sustainability of immunomodulation in provoking CNS repair, even in advanced-stage AD-model mice, while revealing similarities in retino-cerebral responses to therapy, providing incentives to explore retinal AD biomarkers.

Quantifying Retinal Microvascular Morphology in Schizophrenia Using Swept-Source Optical Coherence Tomography Angiography.

Retinovascular changes are reported on fundus imaging in schizophrenia (SZ). This is the first study to use swept-source optical coherence tomography angiography (OCT-A) to comprehensively examine retinal microvascular changes in SZ. This study included 30 patients with SZ/schizoaffective disorder (8 early and 15 chronic) and 22 healthy controls (HCs). All assessments were performed at Beth Israel Deaconess Medical Center and Massachusetts Eye and Ear. All participants underwent swept-source OCT-A of right (oculus dextrus [OD]) and left (oculus sinister [OS]) eye, clinical, and cognitive assessments. Macular OCT-A images (6 × 6 mm) were collected with the DRI Topcon Triton for superficial, deep, and choriocapillaris vascular regions. Microvasculature was quantified using vessel density (VD), skeletonized vessel density (SVD), fractal dimension (FD), and vessel diameter index (VDI). Twenty-one HCs and 26 SZ subjects were included. Compared to HCs, SZ patients demonstrated higher overall OD superficial SVD, OD choriocapillaris VD, and OD choriocapillaris SVD, which were primarily observed in the central, central and outer superior, and central and outer inferior/superior, respectively. Early-course SZ subjects had significantly higher OD superficial VD, OD choriocapillaris SVD, and OD choriocapillaris FD compared to matched HCs. Higher bilateral (OU) superficial VD correlated with lower Positive and Negative Syndrome Scale (PANSS) positive scores, and higher OU deep VDI was associated with higher PANSS negative scores. These results suggest the presence of microvascular dysfunction associated with early-stage SZ. Clinical associations with microvascular alterations further implicate this hypothesis, with higher measures being associated with worse symptom severity and functioning in early stages and with lower symptom severity and better functioning in later stages.

Diabetic Retenopathy Management - A Case Study

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging Retina. It usually takes several years for diabetic retinopathy to reach a stage where it could threaten the sight, if left undiagnosed and untreated. Starting with only a mild vision problem, retinopathy usually appears five years after a type 1 diabetes diagnosis. But it may already be present when type 2 diabetes is diagnosed. We present one such case in a lady of 38 years old, tailor by profession, diagnosed as Type 2 diabetes since 2019, suspected to have had proliferative diabetic retinopathy in January 2020, reported at a Medical College Hospital on 15th December 2020 with periorbital headache for fifteen days. Fundal examination revealed hard exudates and Neo vascularization in both eyes. She was advised Photocoagulation but after her blood sugar was controlled. In the meantime, she was advised to use Nepafenac eye suspension four times daily for pain and redness of the right eye. Investigations had revealed her RBS was 392mg/dl, for which a general physician (internal medicine) was consulted who put her Tab. Metformin 500mg 1-1-1 B/F, Tab. Teneligliptin 20mg 0-1-0 A/F. Unfortunately, 2 months of follow up and diabetes management did not allow her to be taken up for photocoagulation. The institution was firm on their decision to plan her laser photocoagulation for both eyes only when the blood sugar levels come to a range of 140 to 160mg/dl. On 26th March 2021, she was rushed to the Medical College hospital as she complained of loss of vision in the Right eye. The fundus examination revealed multiple dot and blot hemorrhages in both eyes, bleed in oculus dexter and oculus sinister, hard exudates in the right eye that needed Vitreoretinal surgery. Since the Medical College Hospital did not have the Vitreoretinal surgery facility, she was taken to a private dedicated eye hospital, where she underwent laser photocoagulation of left eye on 12/04/21 followed by Vitrectomy of right eye for proliferative diabetic retinopathy on 24th April 2021. There were no postoperative hemorrhages until three days or any other complications after surgery. Now she can recognize some shapes with her right eye by closing left eye.

Controversy of indomethacin eye drops in the treatment of rheumatoid arthritis-induced corneal ulceration: a case report

BackgroundPerforation of the cornea is a rare finding in patients with rheumatoid arthritis (RA). Addressing a perforated cornea associated with RA is challenging, since its pathogenesis is not fully elucidated. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) were developed to prevent cystoid macular edema following cataract surgery in patients at risk. Their prescription in inflammation of the anterior segment of the eye may induce negative effects on the ocular surface. We bring into focus a corneal perforation in a patient with RA who used indomethacin eye drops to treat corneal ulceration, but responded promptly to drug discontinuation and initiation of topical cyclosporine 0.1%. Our aim is to emphasize two issues: the contraindication of topical indomethacin in corneal defects, and the immediate positive impact of topical cyclosporine 0.1% on corneal healing.Case presentationA 73-year-old Caucasian woman with a 13-year history of RA was treated for corneal ulceration in her oculus sinister (OS) with topical indomethacin and gentamicin. The patient was being treated with systemic immunosuppression and NSAIDs for the underlying RA and artificial tears in both eyes. No bandage contact lens was used. After 3 weeks of treatment, perforation of the left cornea occurred and the patient was referred to our hospital. Upon admission, visual acuity (VA) in the OS was 20/630. Slit lamp examination of the OS revealed paracentral corneal perforation, iris plugging the perforation site, shallow anterior chamber, clear aqueous humor, and clear lens. Anterior segment optical coherence tomography showed the inclavated iris in the perforation site and minimum corneal thickness of 101 µm. Topical NSAIDs were discontinued and topical treatment was initiated with tobramycin, tropicamide 1%, phenylephrine 10%, and artificial tears five times a day, and occlusive patch. For 5 days, there was no improvement, so topical cyclosporine 0.1% was started, one drop every evening. Within 7 days, the cornea had healed, the iris was liberated from the perforation site, the minimum corneal thickness increased to 250 µm, VA improved to 20/25, and the patient was free of symptoms.ConclusionsThe main “takeaway” lessons from this case are that topical indomethacin should not be prescribed in cases of inflammation of the anterior segment of the eye, and that topical cyclosporine was efficacious in healing corneal perforation in our patient.

A CASE OF BILATERAL RENAL B-CELL LYMPHOMA WITH UVEITIS AND SECONDARY POLYCYTHEMIA IN A JACK RUSSELL TERRIER

An 8-year-old, castrated male, Jack Russell Terrier was presented with clinical signs of uveitis and glaucoma in the right eye (oculus dexter (OD)) for 2–3 months. Ophthalmic examination revealed OD episcleral congestion, corneal vascularization, aqueous flare, iris bombe, and vision loss. OD glaucoma and uveitis were under control by medical treatment. After 8 months, the dog had acute uveitis in the left eye (oculus sinister (OS)). General physical examination, blood examinations, radiography, and urinalysis were unremarkable. No improvement was observed after for 1 month of uveitis treatment, and more examinations were strongly suggested. Abdominal ultrasonography revealed several hypoechoic masses or cysts on both kidneys. Computed tomography (CT) showed diffuse nonenhancing hypodense patches in both kidneys. Renal tumor was highly suspected, but biopsy was declined by the owner. Ten days after CT examination, the dog suddenly developed anorexia, weakness, uremia, hyperkalemia, and polycythemia. The dog was euthanatized because of the worsening clinical condition, poor prognosis, and financial constraints, and both kidneys were biopsied for histopathology. Immunohistochemically, the neoplastic cells were positive for B-cell marker (CD20) and negative for T-cell marker (CD3). Bilateral renal B-cell origin lymphoma was diagnosed by histologic and immunophenotyping examinations. In conclusion, bilateral renal lymphoma may be diagnosed with no systemic signs except bilateral uveitis. Renal function impairment was acutely developed with severe clinical signs at the end stage of the disease. Early, aggressive, complete examinations, and treatments are strongly recommended.

A Novel Topical Ophthalmic Formulation to Mitigate Acute Mustard Gas Keratopathy In Vivo: A Pilot Study.

PurposeThis pilot study investigated the in vivo therapeutic potential and tolerability of a multimodal ophthalmic formulation, topical eye drops (TED), for acute mustard gas keratopathy (MGK) using a rabbit model.MethodsTwenty New Zealand White rabbits were used. Only right eyes of 18 rabbits (oculus dexter [OD]) received single sulfur mustard gas (SM) vapor injury, whereas contralateral eyes were left untreated or received TED for tolerabilty evaluation. Two rabbit eyes received no treatment and served as age-matched naive control. The four groups were: Naive (oculus sinister [OS] untreated eyes; n = 9); TED (OS treated only with TED BID for 3 days; n = 9); SM (OD exposed to SM vapor; n = 9); and SM+TED (OD exposed to SM+TED BID for 3 days; n = 9). Ocular examination in live rabbits were performed utilizing slit-lamp biomicroscopy, Fantes grading system, fluorescein staining, Schirmer's tests, pachymetry, and applanation tonometry. Cellular and molecular changes in rabbit corneas were assessed after humane euthanasia on day-3 and day-7 with histopathological and real-time polymerase chain reaction PCR techniques.ResultsTED to rabbit eyes was found tolerable in vivo. SM-exposed eyes showed significant increase in Fantes scores, central corneal thickness (CCT), Schirmer's test, epithelium-stroma separation, and corneal edema. TED mitigated clinical symptoms by reducing corneal edema, Fantes scores, CCT, and Schirmer's test. Further, TED decreased SM-induced corneal haze, inflammatory and profibrotic markers, transforming growth factor–TGF-β1 and cyclooxygenase-2COX-2, and damage to corneal structure, including epithelial-stromal integrity.ConclusionsThe developed multimodal eyedrop formulation, TED, has potential to mitigate acute MGK effectively in vivo.Translational RelevanceTED is effective against MGK

Parallels between retinal and brain pathology and response to immunotherapy in old, late-stage Alzheimer's disease mouse models.

Despite growing evidence for the characteristic signs of Alzheimer's disease (AD) in the neurosensory retina, our understanding of retina–brain relationships, especially at advanced disease stages and in response to therapy, is lacking. In transgenic models of AD (APPSWE/PS1∆E9; ADtg mice), glatiramer acetate (GA) immunomodulation alleviates disease progression in pre‐ and early‐symptomatic disease stages. Here, we explored the link between retinal and cerebral AD‐related biomarkers, including response to GA immunization, in cohorts of old, late‐stage ADtg mice. This aged model is considered more clinically relevant to the age‐dependent disease. Levels of synaptotoxic amyloid β‐protein (Aβ)1–42, angiopathic Aβ1–40, non‐amyloidogenic Aβ1–38, and Aβ42/Aβ40 ratios tightly correlated between paired retinas derived from oculus sinister (OS) and oculus dexter (OD) eyes, and between left and right posterior brain hemispheres. We identified lateralization of Aβ burden, with one‐side dominance within paired retinal and brain tissues. Importantly, OS and OD retinal Aβ levels correlated with their cerebral counterparts, with stronger contralateral correlations and following GA immunization. Moreover, immunomodulation in old ADtg mice brought about reductions in cerebral vascular and parenchymal Aβ deposits, especially of large, dense‐core plaques, and alleviation of microgliosis and astrocytosis. Immunization further enhanced cerebral recruitment of peripheral myeloid cells and synaptic preservation. Mass spectrometry analysis identified new parallels in retino‐cerebral AD‐related pathology and response to GA immunization, including restoration of homeostatic glutamine synthetase expression. Overall, our results illustrate the viability of immunomodulation‐guided CNS repair in old AD model mice, while shedding light onto similar retino‐cerebral responses to intervention, providing incentives to explore retinal AD biomarkers.

Importance of neuroimaging in normal tension glaucoma.

Primary empty sella syndrome (PESS) is caused by an increase in the cerebrospinal fluid (CSF) pressure or a defect in the diaphragma sellae, where the pituitary gland is absent or present as a thin membrane.[1] Optic nerve examination and visual field analysis show glaucomatous changes with normal intraocular pressures (IOPs). A 51-year-old male weighing 65 kg presented with gradual progressive painless diminution of vision in both eyes for 1 year with no significant medical or other histories. Best-corrected visual acuity (BCVA) oculus dexter (OD) was counting fingers near face and oculus sinister (OS) was 6/18. Intraocular pressures (IOPs) were normal. A relative afferent pupillary defect in the right eye (RE) was found. Color vision was defective. Gonioscopy revealed open angles in both eyes. Pachymetry was in the normal range. Fundus examination OD revealed a 0.7-cup disc ratio and in OS 0.8-cup disc ratio, with both eyes showing bayonetting, baring of circumlinear vessels, and nasalization of blood vessels, with rim pallor more than cupping suggesting neurophthalmic cause [Fig. 1].Figure 1: Fundus photographs showing advanced optic disc changes with rim pallor in RE and LETwo hourly diurnal fluctuations ranged normal. Visual field examination showed severe generalized depression, tubular field and absence of split fixation in the left eye (LE) [Fig. 2].Figure 2: LE visual field on octopus perimetry G program and M programAll systemic investigations were within normal limits. Magnetic resonance imaging revealed an empty sella [Fig. 3] and venography was non-significant.Figure 3: MRI of the brain and both orbitsNormal tension glaucoma (NTG) is a diagnosis made after excluding causes of burnout glaucoma and previous episodes of acute hemodynamic disturbances.[2] In PESS, nerve fibers in optic chiasm are perfused from the posterior communicating arteries, which pass round the infundibulum above the pituitary gland. If any mechanical changes occur near the pituitary or sella turcica, the arachnoid may be drawn inferiorly simultaneously pulling the optic chiasm and perfusion vessels downward with resultant optic nerve ischemic changes.[3] We need to remember this association between empty sella, NTG and resultant visual loss.[4] Hence, it becomes necessary to include neuroimaging as an added diagnostic tool in our armamentarium for NTG to avoid diagnostic delay and prevent visual disability. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Lichen planus and multifocal choroiditis - A diagnostic dilemma.

A 24-year-old gentleman had a right headache and MFC; for 1 year [Fig. 1a]; being on AKT for 3 weeks with further worsening. Fundus fluorescein angiography (FFA) [Fig. 1b]; optical coherence tomography (OCT), [Fig. 1c] and B-Scan [Fig. 1d] had been done. Serum angiotensin-converting enzyme (ACE), serum uric acid, and QuantiFERON TB Gold Test were normal. Mantoux was 19 mm [48 h/5 tuberculin units (TU)]. Oculus sinister (OS) was normal. On presentation to us, OD had finger counting close to face with congestion; mild relative afferent pupillary defect (RAPD); painful movements; disc edema; peripapillary sub-retinal exudation, and MFC [Fig. 1e]. We did contrast magnetic resonance imaging (MRI) brain/orbit, venereal disease research laboratory (VDRL), antinuclear antibody (ANA), antineutrophil cytoplasmic autoantibody (ANCA), and HIV, which were normal. Paradoxical worsening of TB choroiditis (3 weeks AKT) was considered and intravenous methylprednisolone was used. Repeat history-taking, caused him to recall having skin biopsy-proven LP; treated with oral prednisolone; just prior to ocular symptoms; 1 year back. Pursuing the possibility of flare-up of occult systemic TB; after the use of oral steroids to treat LP, a contrast chest CT was done, which was normal. A previously reported; LP associated intraocular inflammation[1] led us to use of azathioprine. One of the treatment protocols could have been the continuation of AKT, but our physician stopped AKT to avoid hepatotoxicity. Intraocular inflammation resolved within 2 months of azathioprine, [Fig. 1f]; which was continued for 9 months. At 16 months post cessation of azathioprine; he stays in remission.Figure 1: (a) Fundus showing fulminant MFC on treatment with tapering oral steroids for one year. (b) FFA showing late hyperfluorescence; pooling; disc leakage. (c) OCT showing choroidal elevation with macular thickening. (d) B-Scan showing grossly thickened choroid with sub-tenons fluid in macular area. (e) Fundus showing disc edema with peripapillary sub retinal exudation and MFC. (f) Fundus showing resolution of inflammation; 2 months on azathioprineDiscussion Ocular LP is largely extraocular and involves conjunctiva, cornea, and lacrimal drainage system.[2] The role of cellular immunity in LP and retinal vasculitis[34] was believed to be the cause of their once previously reported association.[1] In our patient; there is a diagnostic dilemma of the mere coexistence of LP and MFC with a temporal dissociation (LP occurring just prior to the onset of ocular symptoms) vs possible association between these two otherwise separate immune-mediated clinical entities. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement The authors wish to acknowledge Dr. Avinash Pathengay, for his technical help in the management of this patient.

Lentiviral Vector-Mediated Expression of Exoenzyme C3 Transferase Lowers Intraocular Pressure in Monkeys.

Primary open-angle glaucoma (POAG) is considered a lifelong disease characterized by optic nerve deterioration and visual field damage. Although the disease progression can usually be controlled by lowering the intraocular pressure (IOP), therapeutic effects of current approaches do not last long. Gene therapy could be a promising method for persistent treatment of the disease. Our previous study demonstrated that gene transfer of exoenzyme C3 transferase (C3) to the trabecular meshwork (TM) to inhibit Rho GTPase (Rho), the upstream signal molecule of Rho-associated kinase (ROCK), resulted in lowered IOP in normal rodent eyes. In the present study, we show that the lentiviral vector (LV)-mediated C3 expression inactivates RhoA in human TM cells by ADP ribosylation, resulting indisruption of the actin cytoskeleton and altered cell morphology. In addition, intracameral delivery of the C3 vector to monkey eyes leads to persistently lowered IOP without obvious signs of inflammation. This is the first report of using a vector to transduce the TM of an alive non-human primate with a gene that alters cellular machinery and physiology. Our results in non-human primates support that LV-mediated C3 expression in the TM may have therapeutic potential forglaucoma, the leading cause of irreversible blindness in humans.

Comparison of intraocular pressure and central corneal thickness in non-glaucomatous North- East Indian tribals versus general Indians

Purpose: To compare the intraocular pressure (IOP) and central corneal thickness (CCT) of non-glaucomatous North-East (NE) Indian tribals and general Indians. 
 Materials and methods: In a prospective, cross-sectional study, the IOP and CCT of non-glaucomatous NE Indian tribals (n = 50) and non-glaucomatous general Indians (n = 50) were compared. Glaucoma was ruled out by history, detailed ocular examinations, and investigations.
 Results: There was very good correlation between the CCT and IOP values of right and left eyes (p = 0.940 and 0.847, respectively). The difference in the IOP values in the two groups was not statistically significant (p = 0.312 for Oculus Dexter [OD], p = 0.400 for Oculus Sinister [OS]). Similarly, the difference in the CCT values in the two groups was not statistically significant (p = 0.736 for OD and 0.613 for OS). The mean CCT and IOP OD for the whole population was 530.50 ± 35.42 μm and 13.80 ± 2.760 mmHg, respectively. By linear regression analysis, the IOP OD of the whole population had good correlation with CCT OD of the whole population (adjusted r2 = 0.084, p = 0.002), but not with age (adjusted r2=0.000, p=0.314) and sex (adjusted r2 = 0.010, p = 0.163). Similarly, CCT OD for the whole population did not have good correlation with age (adjusted r2 = -0.009, p = 0.762) and sex (adjusted r2 = -0.007, p = 0.603).
 Conclusions: In this study of individuals with normal corneas and without glaucoma, no racial variation was found in the CCT and IOP values of the two groups. The IOP OD of whole population had good correlation with CCT, but not with age and sex. There was good correlation between OD and OS values of IOP and CCT.

CASE REPORT: SUBCONJUNCTIVAL INJECTION WITH AUTOLOGOUS PLATELET-RICH PLASMA FOR REFRACTORY CORNEAL ULCERS IN A DOG

A 12-year-old, intact, male Golden Retriever dog presented with a 1-month history of corneal ulcer, redness, and occasional squint in the left eye (oculus sinister [OS]). A thorough ophthalmological examination revealed corneal edema, diffuse corneal vascularization, and excessive granulation tissue growth. The tentative diagnosis was chronic superficial keratitis or pannus. After 3 weeks of treatment for OS, blepharospasm and superficial corneal ulceration with a lip of nonadherent epithelium of the right eye (oculus dexter [OD]) developed. No improvement was observed after autologous serum eye drop treatment combined with simple debridement and grid keratotomy on both eyes (oculi uterque [OU]) for 3 months; thereafter, blindness developed. The diagnosis was refractory corneal ulcers. The application of autologous platelet-rich plasma (PRP) was instilled via subconjunctival injection OU every 2 weeks for 2 months. The OU corneas started to re-epithelialize and heal, and the granulation tissues significantly decreased while the vision improved. Therefore, PRP was continued to be administered every 1–2 months for 6 months. After more than 1 year, the OU corneas have healed without recurrent ulceration and with only mild haze. In conclusion, autologous PRP subconjunctival injection is a potentially beneficial addition to the medical management of refractory corneal ulcers in dogs.

Nonsurgical treatment involving a contact lens and hyperosmotic solution for acute bullous keratopathy in a cat

A 4-year-old castrated male Korean domestic shorthair cat was referred with bilateral corneal edema. Focal and generalized acute bullous keratopathy in the oculus dexter and oculus sinister, respectively, were diagnosed by ophthalmologic examinations. Intensive topical treatment was administered to both eyes. A therapeutic soft contact lens was inserted in the oculus sinister as a corneal bandage instead of surgical treatment. The patient achieved complete recovery at 44 days after treatment. A therapeutic soft contact lens and an intensive regimen involving a topical hyperosmotic solution successfully treated acute bullous keratopathy in a feline patient.

Changes in peripapillary blood vessel density in Graves’ orbitopathy after orbital decompression surgery as measured by optical coherence tomography angiography

ABSTRACTThe purpose is to evaluate the utility of optical coherence tomography (OCT) angiography in the evaluation of Graves’ orbitopathy (GO) and response to orbital decompression in patients with and without dysthyroid optic neuropathy (DON). This was a single-center, prospective case series in a cohort of 12 patients (24 orbits) with GO and ±DON, (6 orbits) who underwent bilateral orbital decompression. All patients underwent pre- and postoperative OCT angiography of the peripapillary area. Vessel density indices were calculated in a 4.5 mm × 4.5 mm ellipsoid centered on the optic disk using split-spectrum amplitude decorrelation angiography algorithm, producing the vessel density measurements. Mean change in vessel density indices was compared between pre- and postoperative sessions and between patients with and without DON. Patient 1, a 34-year-old male with GO and unilateral DON OD, showed a significant reduction in blood vessel density indices oculus dexter (OD) (DON eye) after decompression while a more modest reduction was found oculus sinister (OS) with the greatest change noted intrapapillary. Patient 2, a 50-year-old male with DON OU, showed worsening neuropathy following decompression OD that was confirmed by angiographic density indices. Patient 3, a 55-year-female with DON, showed a reduction in blood vessel density OD and increased density OS. Patients without DON showed overall less impressive changes in indices as compared to those with DON. Using OCT angiography, response to surgical treatment in GO orbits, more so in orbits with DON, can be demonstrated and quantified using vessel density indices with reproducibility.

Agreement analysis comparing iPad LCVA and Sloan testing in multiple sclerosis patients

Background: Visual symptoms are common in multiple sclerosis (MS). Low-contrast visual acuity (LCVA) testing using Sloan charts has demonstrated increased sensitivity for visual deficits compared to high-contrast acuity testing. Computerized testing of visual acuity may facilitate use in the clinic setting. Objectives: To evaluate the agreement between an iPad-based and Sloan testing of LCVA in a cohort of MS patients. Methods: A total of 38 patients with relapsing-remitting MS were enrolled after providing informed written consent at Partners MS Center, Brigham and Women’s hospital. Monocular LCVA was measured using retroilluminated Sloan chart and iPad-based LogMAR chart. Number of correct letters and agreement between two measurements were assessed for each eye using Bland–Altman analysis and paired t-test. Results: For both eyes, there was no significant difference in number correct between the two measurements using a paired t-test, and there was high correlation between two measurements (oculus dextrus (OD) r = 0.89, p < 0.001; oculus sinister (OS) r = 0.78, p < 0.001). The limits of agreement were −7.9 to +8.5 letters for the right eye and −10.9 to +11.2 letters for the left eye. Conclusion: An iPad-based LCVA test shows good agreement with Sloan testing in MS patients.

CASE REPORT: EXCISION, AMNIOTIC MEMBRANE GRAFT, CRYOTHERAPY AND INTRALESIONAL MITOMYCIN C INJECTION FOR THE TREATMENT OF A LIMBAL MELANOMA IN A DOG

A four-year-old, female neutered, Shih-Tzu dog was presented with a one-year history of limbal masses on both eyes (OU, oculi utrque). The masses arose from the corneoscleral limbus with marked corneal involvement. An en bloc excision of the involved meridians with human amniotic membrane grafting was performed at the left eye (OS, oculus sinister) limbal masses. A double freeze-thaw cycles of cryotherapy and intralesional mitomycin-C (MMC) injection was performed on both eyes two weeks later. Histopathology provided the definitive diagnosis of limbal melanoma. After 6 months of follow-up, OU limbal masses recurred without intraocular invasion, and 2 cycles of cryotherapy and intralesional MMC injection was then performed on recurrent sites. Despite that both cryotherapy and intralesional injection were applied the lesions recurred at an interval of 4–6 months for 18 months. At the end only a small corneal scar was present on OS, and there was no recurrence for 3 years until now. The cryotherapy combined with intralesional MMC injection was able to control the recurrence of limbal melanoma after tumor excision while maintaining the ocular surface integrity.